Meet Dr. Liden, Part I

Dr. Craig Liden | The Being Well CenterI first became aware of Attention Deficit Disorder or ADD when I was a Pediatric Resident in training at the Children’s Hospital Medical Center in Boston.

When I began my rotations in the outpatient clinics, I expected to face challenging, diagnostic dilemmas involving clear-cut medical problems. Instead, I found that most of the children referred to these clinics were sent because of learning or behavior problems. I soon discovered that ADD was one of the most common reasons for these children’s difficulties.

At the time I really knew nothing about ADD.

I vaguely remembered hearing something about it during a lecture in medical school. As I tried to become more informed about Attention Deficit Disorder, I found that ADD was only superficially described in my textbooks; there was no standard reference book on the topic; and journal articles rarely agreed about what to call it, what it was, what caused it, or what to do about it.

I struggled to apply my simple cause-effect, medical model to ADD and what I got in return was frustration. So did my parents!

As a result of my frustration, I realized I could help myself to better understand and treat learning and behavior problems only with additional training in this area. I participated in a fellowship at Harvard designed to teach pediatricians how to research, teach about, and treat these problems.

During this fellowship, I began to develop an appreciation that learning and behavior problems, like ADD, are far from simple; that they are, in fact, highly complex.

I also learned that, as a physician, I have an important role to play in diagnosing and managing these problems, but that I can never do it alone. To be effective, I need to mesh my knowledge and skills with those of teachers, psychologists, speech-language pathologists, counselors, and others.

During my fellowship training, I had the opportunity to leave the hospital setting and see kids in the “real world.” While conducting research in schools, I was shocked to find that the children I had been seeing at the hospital’s clinics represented only the tip of the iceberg. More than a third of the apparently normal children I worked with demonstrated some type of problem in their learning or behavior. And attention problems were the most common.

After my fellowship, I took a faculty position in the Department of Pediatrics at the University of Pittsburgh and started a program called the Child Development Unit at the Children’s Hospital of Pittsburgh. This position gave me the opportunity to develop and research my own testing procedures for problems like ADD.

Being Well CenterIn addition, I had the chance to put together a unique team approach to address these problems. Team members included social workers, psychologists, special educators, and speech-language pathologists, as well as medical staff.

Throughout my years at Children’s Hospital, I also struggled with the frustration of trying to teach medical students and residents about learning and behavior problems. Similar to the feelings that I had experienced as a Pediatric Resident, most of them hoped to diagnose simple problems that would respond to the neat technological approaches that worked so well in other areas of medicine.

Unfortunately, problems like ADD do not fit this mold.

At this stage in my professional development, I focused too intensely on the diagnosis of problems like ADD and not enough on effective treatment.

Treatment, generally, was limited to a lengthy diagnostic report to a school. These reports concluded with recommendations telling teachers how to do their job better, and they did so without considering the kinds of resources, or lack of resources, at each school.

Needless to say, such pontificators from the ivory tower of the university did not promote the cooperative working atmosphere that would be most beneficial to my patients.

I also tended to refer the management of problems like ADD back to family doctors, pediatricians, or community mental health professionals who frequently had little training or experience. Unknowingly, this approach stirred up everyone’s concern but gave little practical support or guidance about how to deal with the problems.

If I hadn’t had to live with the ramifications of ADD in my own home, I probably would have stayed with the approach for a long time, thinking I was really making a difference in people’s lives… [Read more tomorrow for Part II]


Check back tomorrow for Part II of Dr. Liden’s personal journey that has helped him become a leading international expert on the treatment and diagnosis of ADD/ADHD.

Advertisements

No Pill, No Problem: Why I Denied My Son Had ADD/ADHD

image via Flickr, Angel Breton

image via Flickr, Angel Breton

There has been a great deal of heated public debate about the use and misuse of medication in the treatment of ADD. This debate has been clouded by intense reactions rooted in strong attitudes, beliefs, and misconceptions. As a result, many people, unnecessarily, fear the use of medication. It is my hope that an objective, comprehensive, and responsible discussion of medication will open some closed minds, dispel fears, calm anxiety, provide new perspectives, and clarify misunderstanding.

If the medications are so important, what stands in the way of people using them?

In my experience, one of the most common reasons people hesitate to use medication in the treatment of ADD is lack of acceptance.

There is no escaping the fact that you have a problem when you take a pill for it and, frankly, nobody wants to have a problem.

In my own circumstance, I saw the signs of ADD in my older son when he was 9 months old, but the words “Attention Deficit Disorder” didn’t touch my lips until he was 9 years old!  This was a reflection of my struggle with acceptance . . . he looked perfectly normal on the outside and I didn’t want him to have a problem on the inside. I wrote off his impulsivity and distractibility as immaturity or his being “all boy.”  In turn, I constantly nagged him and tightly structured every part of his life. By the time he finally got proper treatment with medication, I had inadvertently contributed to deflating his self-esteem.

When one of the most important people in your life is repeatedly saying, “You could do better if you tried harder” and despite your best efforts, you don’t measure up, you’re left thinking you must be either “lazy” or “stupid.”

So, by allowing things to get to the “last resort” before using medication, we run the risk of contributing to the development of a vicious failure cycle. The resulting low self-esteem and poor motivation make effective treatment much more difficult.

Furthermore, without the medication as an aide, the ADD individual is at high risk for over-relying on his parents, spouse, teachers, boss, and others in his life for reminders and structuring.  This promotes an unhealthy co-dependency and enables the ADD individual to avoid taking responsibility for his behavior.

Pay Attention!  5 Things You Need to Know (but don’t) About ADD/ADHD

Dr. Craig Liden | The Being Well Center

Based on my observations and studies treating ADD for the past 30 years, it’s fair to say that ADD touches upward of 20% of our population.  More than ever, we need to understand this often misunderstood, misaligned disorder.

People who are treating their ADD are living and thriving.  Let’s make the path to accurate diagnosis and effective treatment plans clear for all.

5 Things Everyone Should Know About ADD/ADHD:

1.    Attention Deficit Disorder is very common in adults. It is suspected that 1 in 25 adults has ADD.  However, only half have been properly diagnosed and less than a quarter are being properly treated.

2.    Untreated adult ADD can result in many chronic issues: obesity, chronic bowel problems, addiction disorders, depression/anxiety, and college failure, not to mention failed relationships, accidents, or poor job performance.  Properly diagnosing and treating ADD could have a huge impact on our society and health care system.

3.    Proper treatment of ADD with medication and counseling always starts with a comprehensive, diagnostic evaluation that includes objective testing, feedback from various members of the patient’s life, and a look at the whole person.

4.    Risks associated with correct medication use are minimal compared to the risks of untreated ADD.  Medication is often necessary but never sufficient and should always be paired with supportive counseling.  Stimulant medications used to treat ADD are generally very safe and are not addictive.

5.    The preferred name for ADD/ADHD is ADD since “Hyperactivity” is only one of many symptoms of ADD patients and shows up in less than 10% of those diagnosed.

Dr. Craig Liden is the Founder and Medical Director of The Being Well Center, an ADD/ADHD diagnostic and treatment center in Pittsburgh, PA that has helped more than 10,000 people worldwide living with ADD.

TRANShealth Inc. is sponsoring a free download of Dr. Liden’s book, ADD/ADHD Basics 101, in which Dr. Liden gives 10 steps to securing a diagnosis and treatment plan you can trust. 

 

STRESSES – The Challenge of Taking Medication at College

When students arrive on campus, the demands for efficient attention and self management skills (that is executive functioning) immediately soar . . . challenging academics, consistent study habits, maintenance of healthy daily routines for sleep, eating and exercise, money management, and more complex social decision making.

c@c_whole_you_blog_stresses

Meeting college demands is particularly challenging for students with ADD/ADHD and for the overwhelming majority of them, this means having the aid of a medication regimen that provides benefits throughout the whole day.

We’ve learned from our experience in our Confidence@College program that college is a bad time to try to “fly on my own” and go without medication treatment.  In fact, in our C@C patient population, we have found that acceptance of the need for medication and compliance with an appropriate all-day medication regimen is near the top of the list of factors that contribute our 81% success rate.

For some ADD/ADHD individuals who have been able to get by without medication in the past, entrance into college with its increased demands means having to seriously consider the use of medication for the first time.  For others who have been able to get by with a medication regimen geared to get them through the school day, it means revising their regimen to provide coverage into the evening hours.  And for others, it means committing to taking the medication 7 days a week!

Don’t let an improper use or lack of medication keep you or your student from success at college!

At The Being Well Center, patients who enroll in our Confidence@College program always start with a Discovery Session where we identify the key problem areas and survey the whole person so we can pinpoint the barriers to success and uncover strengths we can mobilize to meet these new challenges.  We then develop an individualized Success Plan.  When medication is a part of the success plan we conduct systematic medication trial testing using objective testing procedures to find the right medication and a treatment regimen that provides efficient attention throughout the waking day.

Before students arrive on campus we brainstorm with them and their parents how they are going to get their medication and how to securely store it.  We go over the logistics of when they will take the medication based upon their weekly schedule.  In addition, we review the dangers of diversion of the medication and make sure we have a mechanism in place to closely track the quantity of medication we provide them.

Once students are on campus, we use innovative technologies and support from our staff through our GuideU video counseling sessions to ensure the student complies with the medication regimen and maintains healthy daily routines, the foundation for a successful medication experience.  We identify signs of sub-therapeutic treatment and possible side effects quickly and our medical staff fine tunes the treatment regimen as needed.

We’re there to ensure success during the whole college experience not just in the classroom, library or study carrel.  We make sure our patients are aware of the importance of taking the medication during evening hours and weekends where social activities provide high risk challenges for un-medicated ADD/ADHD students.  Impulsivity, poor self awareness, weak self monitoring and ineffective problem solving can lead to social decisions that can be disastrous . . . alcohol intoxication, substance abuse, unprotected sex leading to unplanned pregnancy or STD, or illegal activities.  One night of un-medicated “fun” can lead to expulsion from school and life-long consequences.

If you’re at the top of your game, college can be an exciting and enriching experience intellectually, developmentally, and socially, and can provide you with what it takes to independently fulfill your dreams and aspirations through life.  Compliance with the right medication regimen helps this become a reality for students with ADD/ADHD!

Be confident with your child’s success at college . . . call us at the BWC and set up an appointment to participate in our C@C program.  We’ll make sure your child has all the tools, including an optimal medication regimen if needed, to succeed at college.

NEUROMATURATION – ADHD and the Secrets of the “Freshman 15”

We’ve all heard about them… the dreaded “freshman 15!”   Good old dorm food where the only choices that taste good to you seem to be those with high fat and carbohydrate content.  A huge stash of of high calorie snacks only an arm’s reach away in your dorm room.  Late night delivery pizza or runs to the sub shop with your new found friends.  Beer!

It all adds up pretty quickly and many a parent has been shocked at semester break to see that their kid’s cheeks are a little bit fuller and their jeans a bit tighter.

c@c_whole_you_blog_neuromaturation

While most students face the challenge of avoiding the “freshman 15”, the task can be particularly daunting for the college student with ADHD.  They struggle to get up and out of bed in the morning, often at the last minute, skipping breakfast and making it to class just in the nick of time.  Lunch can also be a catch as catch can experience…something always gets in the way… too little time between classes, last minute cramming for a test, frisbee with friends, flirting with that cute guy from English class.  The brain interprets these  day long fasts as starvation and in response it slows down the metabolic rate so that even if they eat the normal number of calories for dinner (which rarely happens) all the extra calories are sent to the fat cells to prepare for starvation again tomorrow.  This is how eating less can actually contribute to weight gain!

ADHD individuals notoriously make poor food choices, eat impulsively and fail to exert portion control, and choose high calorie drinks when they are thirsty.  These unhealthy eating habits are even more likely to occur when Mom is no longer around to set limits and nag!  These concerns are magnified when the student moves out of the dorm and into an apartment.  Many don’t have much of an idea of how to prepare healthy meals so they don’t go grocery shopping with a meal plan in mind and instead rely on prepared food or frozen dinners that are often calorically dense!

Despite the best intentions, it’s hard to get to the fitness center for a workout and structured sports are gone for most.  Some colleges still mandate a physical education course or two for graduation but many don’t.  Free time is usually spent hanging out with friends playing video games and eating chips.

As the stresses mount during the semester,  many ADHD students turn to food as a self medicating coping strategy to either enhance their focus or to reduce their anxiety or depression.  One candy bar may do the trick for 20 minutes but then there is the crash and a need to “dose up” again!

This is all laid on a backdrop of an increasing awareness we have that ADHD is a significant contributor to the obesity epidemic.  While it may seem counterintuitive, we now know that “hyperactive” kids are at high risk for being overweight as adults.  Studies have shown that more than 40% of adults participating in weight management clinics have unrecognized or untreated ADHD!  In our experience, leaving home and heading off to college is the first step down the road to a lifetime struggle weight management.

For many, the slow steady progression toward obesity and all its challenges and risks begins with the “freshmen 15″…we all know that once it’s on it’s really hard to get off!

It doesn’t have to be this way…with a comprehensive success plan including a structured schedule for study time, a healthy daily routine for eating, exercise, sleep, and relaxation, targeted accommodations, and compliance with a proper medication regimen along with ongoing support from an experienced professional, ADHD students can experience success in the classroom AND in the other spheres of life!

Confidence@College means taking advantage of enriching experiences and relationships in order to acquire the tools, skills, and the habits to succeed at work, at home, and in health for a lifetime.  Call us today and set up a Discovery session so we can begin helping your child chart a personalized course for life success!

P.S.  If you’re not a college student but a parent with ADHD (or who thinks you may be) who can relate to these issues and struggles with weight management, there is help for you, too.  Contact the Being Well Center and ask about getting involved with our TRANSforming U Program.  Let us help you become a healthier U!